Chronic rhinosinusitis (CRS) is a common, biologically heterogeneous disease in which diagnosis, endotyping, therapy selection, and surgical decision-making all remain imperfect. Over little more than a decade, artificial intelligence (AI) applied to CRS has advanced from classical regression to machine learning, deep learning, and, most recently, computer vision and generative models, producing tools that now touch the entire care pathway. This review synthesizes that progress across four present-day capabilities and two emerging frontiers. In diagnosis, machine learning predicts probable CRS from pre-visit data while convolutional networks interpret CT, nasal endoscopy, and histopathology and infer eosinophilic endotype noninvasively. In endotyping, supervised, unsupervised, and latent-factor models, together with image-based deep learning, resolve molecularly defined subsets in CRS, repeatedly implicating IL-5 and mixed type 2/neutrophilic inflammation. In therapeutics, machine learning clarifies medical-therapy response and identifies molecular predictors of biologic benefit. In surgery, models forecast endoscopic sinus surgery success and disease recurrence, converging on asthma, radiographic sinus opacification, and eosinophilic or neutrophilic inflammation. Looking ahead, multimodal foundation models, federated learning, and computer-vision-guided intraoperative navigation promise integrated, patient-specific decision support. We also weigh the risks and limitations of AI in CRS care and outline unmet needs, including the case for international consensus on how AI is developed and evaluated. Across domains, complex algorithms do not consistently outperform parsimonious models, and external validation remains the principal barrier to clinical translation.

Neutrophilic inflammation is increasingly recognized in difficult-to-control asthma, chronic rhinosinusitis with nasal polyps (CRSwNP), and allergic rhinitis, but its clinical interpretation remains challenging. Neutrophilia may coexist with type 2 (T2) inflammation and can also arise from infection, smoking, environmental exposure, obesity, treatment effects, or transient exacerbation biology; therefore, it should not be equated automatically with a stable non-T2 endotype or corticosteroid resistance. This review focuses on how clinicians can identify and act on a clinically meaningful neutrophilic treatable trait across the united airway. Direct airway assessment, particularly induced sputum in asthma and nasal cytology or tissue assessment in upper-airway disease, provides the closest measure of local inflammatory phenotype, whereas peripheral blood and soluble biomarkers remain supportive rather than interchangeable surrogates. Reproducibility, clinical context, and exclusion of secondary causes are essential before assigning therapeutic significance to neutrophilia. No neutrophil-specific biologic is currently approved for asthma, CRSwNP, or allergic rhinitis. Macrolides provide the clearest clinically available bridge in selected patients, but treatment response is not defined by a validated neutrophil cutoff. Trials targeting CXCR1/2 or IL-17 pathways demonstrate that reducing neutrophilic inflammation does not necessarily translate into meaningful clinical benefit, whereas NET- and cGAS-STING-directed strategies remain investigational. A practical treatable-trait approach should integrate validated coexisting T2 traits, direct airway phenotyping where feasible, evidence-based or trial-based treatment selection, and longitudinal reassessment of both inflammatory phenotype and clinical outcomes.

Background Septoplasty is frequently performed with functional endoscopic sinus surgery (FESS), either during the same operative session or as a staged procedure. Whether same-day versus staged septoplasty with FESS is associated with differences in postoperative corticosteroid use or postoperative nasal polyp diagnosis remains unclear. Objective The study aimed to compare postoperative corticosteroid use and postoperative nasal polyp diagnosis after same-day versus staged septoplasty with FESS. Methods We performed a retrospective cohort study using the TriNetX U.S. Collaborative Network. Adults undergoing both septoplasty and FESS were categorized into same-day and staged cohorts, with staged procedures separated by at least 30 days. One-to-one propensity score matching balanced age, sex, race, baseline nasal polyp diagnosis, and baseline systemic and intranasal corticosteroid use. The index date was the FESS procedure date. Postoperative corticosteroid use was assessed from 15 to 180 days after FESS, and postoperative nasal polyp diagnosis was assessed from 15 to 730 days. Results After matching, 3,171 patients remained in each cohort. Systemic corticosteroid use occurred in 925 same-day patients (29.17%) and 825 staged patients (26.01%; risk difference, 3.15%; 95% confidence interval (CI), 0.96%-5.35%; odds ratio (OR), 1.17; 95% CI, 1.05-1.31; p = 0.0050). Intranasal corticosteroid use occurred in 1,283 same-day patients (40.46%) and 1,070 staged patients (33.74%; risk difference, 6.72%; 95% CI, 4.35%-9.09%; OR, 1.33; 95% CI, 1.21-1.48; p < 0.0001). Postoperative nasal polyp diagnosis did not differ significantly between cohorts (28.82% vs 26.96%; hazard ratio, 1.08; 95% CI, 0.98-1.18; log-rank p = 0.1189). Conclusions Compared with staged surgery, same-day surgery was associated with significantly higher postoperative systemic and intranasal corticosteroid prescribing, but there was no statistically significant difference in postoperative nasal polyp diagnosis between cohorts. These findings are hypothesis-generating and should not be interpreted as evidence that staging reduces total corticosteroid burden or provides equivalent endoscopic disease control. Further prospective studies with standardized medication capture, symptom scores, and endoscopic follow-up are needed to clarify whether surgical timing influences postoperative inflammatory control after septoplasty and FESS.